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Biomedical subjects

S Sabanathan

Publications and source records attributed to S Sabanathan.

At least 55 records · Page 3Linked to original sources
PubMed1994

Use of metallic stents in relapsing polychondritis.

Relapsing polychondritis is a rare multisystem disease. We describe the presentation and treatment of a patient with relapsing polychondritis and review the literature. This patient had involvement of the tracheobronchial tree requiring insertion of metallic stents.

Aged↗
PubMed1994

Superior mediastinal mass causing gastric outlet obstruction.

We present a unique case of a 63-year-old male patient with a squamous cell carcinoma of right upper lobe with paratracheal lymphadenopathy and symptoms of superior vena caval obstruction treated by radiotherapy, presented seven months later with symptoms of gastric outlet obstruction. Upper GI endoscopy and barium studies confirmed the diagnosis of functional gastric outlet obstruction. He was treated by an antecolic gastrojejunostomy. We postulate that the superior mediastinal mass with vagal nerve entrapment at the thoracic inlet resulted in symptoms of gastric outlet obstruction.

Carcinoma, Squamous Cell↗
PubMed1994

Self-expanding tracheobronchial stents in the management of major airway problems.

The management of patients with critical major airway obstruction has been made possible by the recent introduction of expandable metal stents as the sole treatment or as an adjunct to other treatment modalities. To alleviate the distressing symptoms from tracheobronchial obstructions Gianturco self-expanding stents were used successfully in the management of 16 patients. The indications were; stenosis from postoperative strictures and recurrent tumours (n = 6), extrinsic compression from metastatic disease (n = 4), inoperable primary tumours of central airways (n = 4), airway collapse from relapsing polychondritis (n = 1), and endobronchial non-Hodgkin's lymphoma (n = 1). Fourteen patients have immediate relief of stridor and the remaining two patients were successfully weaned from ventilatory support. The stents were inserted under general anaesthesia through a rigid bronchoscope under direct vision. The ease of insertion under radiological control, self-expanding nature of the stents and the lack of major complications on follow-up of up to 22 months are particular advantages. The self-expanding tracheobronchial stents are a useful addition to our armamentarium in maintenance of the airways in patients with major airway stenosis and collapse.

Adult↗
PubMed1994

Management of postpneumonectomy bronchopleural fistulae. A review.

The management of postpneumonectomy bronchopleural fistulae continues to constitute a major therapeutic challenge. Refinements of surgical techniques have reduced the incidence of this dreaded complication although it cannot be totally prevented. Management remains controversial. We report our recent experience of three patients with bronchopleural fistulae following a right pneumonectomy, two for bronchogenic carcinoma and another for non-tuberculous, suppurative lung disease. Our treatment of choice for these patients is, immediate pleural drainage together with parenteral broad spectrum antibiotics followed by endoscopic closure of the fistula with monomeric n-butyl-2-cyanoacrylate glue (Histoacryl blue, B Braun, Melsungen, Germany). The pleural space is then irrigated with Povidone Iodine to sterility following which the closed bronchial stump is reinforced following which the closed bronchial stump is reinforced and the pleural space obliterated by decortication, omentopexy and by a tailored thoracoplasty. This cosmetically acceptable treatment produces minimal functional disability and is achieved with minimal morbidity and mortality in these critically ill patients.

Aged↗
PubMed1994

Efficacy of pre-emptive analgesia and continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics.

OBJECTIVE: Thoracotomy results in severe pain and deleterious changes in pulmonary physiology. The literature suggests that these alterations in pulmonary mechanics are inevitable and can only be minimised but not prevented by effective analgesia. We have re-evaluated this concept and assessed the efficacy of pre-emptive analgesia [preincisional afferent block, premedication with opiate and/or non-steroidal anti-inflammatory drug (NSAID)] in conjunction with postoperative extrapleural continuous intercostal nerve block on postoperative pain and pulmonary function. MATERIALS AND METHODS: A prospective randomized study was conducted on 56 patients undergoing elective thoracotomy. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and 12 hourly for 48 hours after operation. There were seven patients in each of the eight groups. RESULTS: The balanced analgesia group comprising preincisional block and premedication with opiate and NSAID (Group 1) had significantly better analgesia, needed less postoperative supplementary analgesics and maintained their preoperative pulmonary function postoperatively irrespective of the nature of the operation. The ranking of importance of the three components of the pre-emptive analgesia as assessed in this study are preincisional block, opiate premedication and premedication with NSAID's. No significant change in plasma levels of cortisol or glucose occurred in Group 1 patients from prior to induction of anaesthesia to 24 hours postoperatively, suggesting effective somatic and sympathetic afferent blockade had been achieved in these patients. There were no complications related to the infusion or the use of NSAID's. CONCLUSIONS: We conclude that a balanced analgesic regime comprising preoperative pain prophylaxis and postoperative maintenance analgesia by NSAID and continuous extrapleural intercostal nerve block will minimise and even reverse the expected decline in lung function after thoracotomy. The postoperative decline in lung function is not obligatory but primarily due to incisional pain and thus is preventable by effective analgesia. An ideal balanced pre-emptive analgesic regime should include preincisional local anaesthetic afferent block and premedication with opiates and a NSAID:

Administration, Rectal↗
PubMed1993

Continuous intercostal nerve block versus epidural morphine for postthoracotomy analgesia.

Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. Pulse oximetry monitoring was used to determine the incidence of hypoxemia. No significant difference was observed between the groups concerning pain relief (except at 28 hours, in favor of the intercostal nerve block group), respiratory performance, or arterial oxygen saturation. Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.

Adult↗
PubMed1993

The use of tissue adhesive in pulmonary resections.

One hundred eighty-seven consecutive patients underwent resection of primary bronchogenic carcinoma with intraoperative application of monomeric n-butyl-2-cyanoacrylate glue from July 1987 through December 1992. The glue reinforced either the stapled bronchial stump (135 patients), the sutured bronchial anastomosis in sleeve resections (37 patients) or the staple lines of wedge resections (15 patients). Mortality was 1.6% overall (3 of 187), and 5% among pneumonectomies (2 of 40). Bronchopleural fistulae occurred in 0.5% (1 of 187) of all pulmonary resections and 2.5% of pneumonectomies (1 of 40). There was no fistula in the lobectomy or sleeve resection groups. Bronchial anastomosis was accomplished in patients who underwent sleeve resection with four interrupted apposing sutures and airtight closure ensured by the tissue adhesive. There was no incidence of bronchial stenosis. There were no cyanoacrylate adhesive-related complications. A follow-up of the patients up to 68 months has indicated not only its effectiveness but also its safety. Monomeric n-butyl-2-cyanoacrylate glue is safe, offers protection to bronchial margins and may be valuable in preventing bronchial stenosis after sleeve resections.

Adolescent↗
PubMed1993

Plasma concentrations of bupivacaine and its enantiomers during continuous extrapleural intercostal nerve block.

Plasma concentrations of bupivacaine have been measured in 12 patients given bupivacaine through a paravertebral catheter placed under direct vision at thoracotomy. After an initial bolus of 0.5% bupivacaine 20 ml, mean (SEM) Cpmax was 1.45 (0.32) micrograms ml-1 and median (range) tCpmax was 25 (10-60) min. A concentration of 4.43 micrograms ml-1 measured in one patient was not associated with toxic signs. During continuous infusion of bupivacaine for 120 h, Cpmax was 4.9 (0.7) micrograms ml-1 and tCpmax 48 (5-96) h. No symptoms or signs of toxicity occurred. Separate measurement of R- and S-bupivacaine concentrations demonstrated significantly different concentration-time profiles.

Adult↗
PubMed1993

Management of superior vena cava obstruction with self-expanding intraluminal stents. Two case reports.

Obstruction of the superior vena cava was relieved in two patients by intraluminal, self-expanding Gianturco stents percutaneously inserted in local anaesthesia. The cause of the obstruction was inoperable oat cell carcinoma of the bronchus in one case and irradiation for squamous cell carcinoma of the right upper lobe in the other case. Stenting gave immediate relief of symptoms in both cases, with no complications. Intraluminal stenting is a useful adjunct in the management of patients with obstruction of the superior vena cava.

Aged↗
PubMed1993

Post-thoracotomy analgesia.

The severity of postoperative pain after thoracotomy means that total analgesia cannot be achieved with a single method or agent without significant side-effects. Recent advances in our understanding of the mechanism of pain generation and maintenance mean that measures prior to surgery greatly affect the requirement for postoperative analgesia. We review the methods available for post-thoracotomy analgesia in the light of our knowledge of peripheral and central mechanisms of neuronal hypersensitivity. The combination of opiate premedication, preoperative non-steroidal anti-inflammatory drugs (NSAIDs), preincisional regional block and postoperative continuous paravertebral block together with NSAIDs may be the ideal combination for near total analgesia following thoracotomy.

Analgesia↗
PubMed1993

Endobronchial non-Hodgkin's lymphoma.

Endobronchial involvement in non-Hodgkin's lymphoma is rare even in the presence of advanced disease. Two cases of endobronchial non-Hodgkin's lymphoma are presented and the findings in 31 previously reported cases reviewed. There were 16 cases with diffuse involvement in the presence of intra or extrathoracic non-Hodgkin's lymphoma and 15 cases with central airways involvement in the absence of clinically apparent systemic disease. Chemotherapy with or without radiotherapy is mandatory for all patients with disseminated disease and for those patients with primary endobronchial non-Hodgkin's lymphoma with residual disease after resection, or if resection is not feasible. Older patients should be treated with curative intent unless concomitant intercurrent illness precludes combination chemotherapy. Rapid deterioration in dyspnoea from airway obstruction in non-Hodgkin's lymphoma may be relieved with a self-expanding endobronchial stent.

Bronchial Neoplasms↗